1. Field of the Invention
This invention relates generally to a method and apparatus for use in surgical procedures, and more particularly, to a method and apparatus for performing pectus excavatum repair.
2. Discussion of the Related Art
Pectus excavatum, also known as funnel chest, is one of the most common anterior chest wall deformities. Patients exhibiting this deformity range from having a mildly depressed sternum to other extreme cases in which the sternum is positioned substantially adjacent to the vertebrae column. This depression or deformity is produced by posterior depression of the sternum and the lower costal cartilages. Specifically, the body of the sternum is generally angled posteriorly towards the vertebrae generally starting below the second costal cartilage. The costal cartilages are then angled posteriorly to meet the sternum, thereby creating a depression in the chest wall.
Surgical repair of pectus excavatum dates back for many years. A history of such surgical repairs is set forth in an article entitled "Congenital Chest Wall Deformities" which is set forth in "Current Problems In Surgery", Volume XXXIII, No. 6, June 1996, which is hereby incorporated by reference. In general, the current surgical repair techniques all involve resection of the deformed costal cartilage and sternal osteotomy. In this regard, the sternum is separated and elevated anteriorly and supported by securing the sternum with a variety of internal fixation devices.
One of these devices is produced by V. Mueller and is known as an Adkins Strut. This strut generally consists of an elongated rectangular shaped bar having a rectangular cross-section that can be bent manually to hold the sternum in a slightly over-corrected position. This strut is generally laid behind the lower half of the body of the sternum, with the separated sternum laid atop the strut. The strut is anchored on each side at the appropriate position to a rib exposed by a myotomy through the pectoral muscles. Holes positioned at each end of the strut are then used to facilitate fixation by means of sutures. This strut has a thickness of 1.5 mm, provides an estimated bendable strength of about 24 in-lbs (inch-pounds) and a bendable stiffness of about 232 lb-in.sup.2 (pounds times inches squared), as estimated and determined in accordance with the procedure set forth in ASTM (American Standard Test Method) F382 and further discussed herein. This strut also has an estimated yield strength of about 25.times.10.sup.6 psi (pounds per square inch) based upon the material used for this strut.
However, use of the above-identified procedures and internal fixation devices suffer from many disadvantages. For example, in each of the noted surgical procedures, resection of the costal cartilage and sternal osteotomy is performed which is a long and complex surgical procedure that has considerable blood loss and a significant complication rate. Moreover, such surgery produces an unsightly scar in the anterior chest area. It has also been found that the use of the internal fixation strut produced by V. Mueller has a bendable strength, bendable stiffness and yield strength which are not sufficient to support the sternum in Applicants' new minimally invasive technique. This strut further does not provide for stabilization of the strut ends by means other than fixation with sutures which is generally not sufficient in many adolescent patients and older or for Applicants' new procedure. Furthermore, the blunt or squared ends of this bar are also difficult to guide through a patient and may tear and catch on soft tissue.
What is needed then is a method and apparatus for performing pectus excavatum repair which does not suffer from the above mentioned disadvantages. This in turn, will provide a minimally invasive technique which does not require cartilage resection or sternal osteotomy, eliminates the need to raise pectoralis muscle flaps, reduces surgical complexity, reduces blood loss, reduces surgical time and cost, eliminates any anterior chest wall incision or scar, provides early return to full activities, provides normal long term chest strength, expansion, flexibility and elasticity, and provides excellent long term cosmetic results. It is, therefore, an object of the present invention to provide such a method and apparatus for performing pectus excavatum repair.